Provider Demographics
NPI:1740748292
Name:BODHI, ROBIN KATHLEEN
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:KATHLEEN
Last Name:BODHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 METZGER RD
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:WA
Mailing Address - Zip Code:98610-3098
Mailing Address - Country:US
Mailing Address - Phone:503-477-0931
Mailing Address - Fax:
Practice Address - Street 1:52 METZGER RD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:WA
Practice Address - Zip Code:98610-3098
Practice Address - Country:US
Practice Address - Phone:503-658-9557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R7677101YP2500X
OR12722225700000X
WA61355560101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist